Senior Case Manager (RN)

About the role

The role of Senior Case Manager is critical to ensuring that members receive the right care at the right time. You will play a pivotal role in improving the quality and efficiency of care delivery.

Responsibilities

• Review claims data, prior authorizations, and admission/discharge feeds to identify members who need case management support.
• Conduct clinical assessments and build individualized care plans with members.
• Coordinate directly with primary care physicians, specialists, hospitals, and post-acute providers to ensure care plans are executed and gaps are closed.
• Support members through complex episodes such as new diagnoses, hospitalizations, transitions of care, and chronic condition management.
• Partner with our utilization management workflows on medical necessity questions and appropriate level of care.
• Help build the playbook: contribute to protocols, escalation pathways, and the tooling we use to do this work well.
• Document thoroughly and maintain compliance with applicable regulatory and accreditation standards.

Requirements

• Active, unrestricted RN license; multi-state compact license strongly preferred.
• 5+ years of clinical nursing experience, with relevant experience in case management, utilization management, care coordination, or discharge planning.

Qualifications

• Comfort reading and interpreting claims data, prior auth criteria (MCG/InterQual), and clinical documentation.
• Strong communication skills — able to hold your own with a skeptical specialist and also meet a member where they are.
• Self-directed; able to run your panel without someone over your shoulder.
• Comfort working in a fast-moving environment where processes are still being built.

Skills

• Experience using AI to improve healthcare outcomes.

Benefits

• Profitable, covering hundreds of millions in premiums and tens of thousands of members.
• Growing quickly through brokers, employers, and partners.
• Backed by leading venture capital firms: Upfront Ventures, 8VC, and General Catalyst.
• A team with deep expertise from Palantir, YC companies, and longtime healthcare operators.

Pay

$90,000 - $110,000 base salary, plus bonuses determined based on experience and qualifications.

Schedule

Full-time position.

Contact

To apply, visit https://apply.arlohealth.com.